Last reviewed: November 2017
Last updated: November  2016

Summary

Definition

History and exam

Key diagnostic factors

  • recent sinus infection
  • recent eyelid injury
  • redness and swelling of eye
  • ocular pain
  • decreased vision
  • proptosis
  • eyelid edema
  • insect bite on eyelid
  • stye or chalazion
  • ear or facial infection
  • ophthalmoplegia and diplopia

Other diagnostic factors

  • orbital trauma
  • skin infection
  • chemosis
  • tenderness around eye
  • fever
  • eyelid erythema
  • elevated intraocular pressure
  • headache
  • malaise
  • previous dental infection or dental work
  • orbital fracture
  • foreign body in eye or orbit
  • drowsiness
  • nausea/vomiting
  • nasal discharge

Risk factors

  • sinusitis
  • young age
  • male gender
  • lack of Hib vaccine in children

Diagnostic investigations

1st investigations to order

  • clinical exam
  • CT sinus and orbits with contrast
  • WBC count
Full details

Investigations to consider

  • blood culture
  • microbiology swabs (conjunctiva, nasopharnyx, external wounds)
  • MRI head and orbits with contrast
  • lumbar puncture
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Oculofacial Plastic and Reconstructive Surgery

Department of Ophthalmology

Kaiser Permanente Medical Group

Union City

CA

Disclosures

HJK declares that she has no competing interests.

Professor of Clinical Ophthalmology

Department of Ophthalmology

University of California San Francisco

San Francisco

CA

Disclosures

RK declares that he has no competing interests.

Dr H. Jane Kim and Dr Robert Kersten would like to gratefully acknowledge Dr Sandra Lora Cremers and Dr Sarosh Janjua, previous contributors to this monograph. SLC and SJ declare that they have no competing interests.

Peer reviewers VIEW ALL

Director of Cosmetic Dermatology

Department of Dermatology

Cosmetic and Procedural Dermatology

Henry Ford Health System

Detroit

MI

Disclosures

DMO declares that he has no competing interests.

Resident

Wilmer Eye Institute

Baltimore

MD

Disclosures

IW declares that she has no competing interests.

Staff Physician

Cleveland Clinic

Cleveland

OH

Disclosures

CR declares that she has no competing interests.

Specialist Registrar in Ophthalmology

Royal Victoria Infirmary

Newcastle

UK

Disclosures

JS declares that he has no competing interests.

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